Three-Dimensional Transesophageal Echocardiography Is Useful for Preventing Prosthetic-Patient Mismatch After Surgical Aortic Valve Replacement

Introduction: Prosthesis-patient mismatch (PPM) in surgical aortic valve replacement (SAVR) is known to be a poor prognostic factor. However, the parameters for preventing postoperative PPM in SAVR have not been established. Materials and Methods: Two hundred and five patients (mean age 72.5 +/- 7.4 years, 129 males) who underwent SAVR were analyzed. Preoperatively, we determined the recommended prosthesis valve size from the mean aortic valve (AV) diameter derived from the AV annulus area by preoperative three-dimensional transesophageal echocardiography (3D-TEE). We investigated the association between pre- and postoperative changes in annulus diameter and the occurrence of PPM. Results: PPM was present in 6 patients (2.9%). Pre- and postoperative AV annulus diameter change ratio was greater in the group with PPM than in that without PPM (10.4 +/- 3.6% vs. 3.0 +/- 5.6%, p = 0.002). The use of prosthetic valve rings smaller than the recommended size was higher in the group with PPM than in that without PPM. (83.3% vs. 20.6%, p = 0.002). On multivariate logistic regression analysis, use of a valve smaller than the recommended size was an independent predictor of PPM (odds ratio 19.3, 95% confidence interval 2.14-174.5, p = 0.008). Conclusions: The recommended prosthetic AV size based on preoperative 3D-TEE is useful for determining the optimal prosthetic AV size to prevent PPM after SAVR.